Dr.Saman Anwar Faraj psychiatrist M.B.Ch.B, F.I.B.M.S (psych) psychopathology
Preview:
Citation preview
- Slide 1
- Dr.Saman Anwar Faraj psychiatrist M.B.Ch.B, F.I.B.M.S (psych)
psychopathology
- Slide 2
- Mental disorders are characterized by abnormalities in
thoughts, perceptions, mood, and behavior that deviate from a
socially defined norm enough to impair social functioning. So,
psychopathology is the study of these deviations, the symptoms and
signs of mental disorders, their etiology, and their
pathogenesis.
- Slide 3
- Culture the enduring behaviors, ideas, attitudes, and
traditions shared by a large group of people and transmitted from
one generation to the next Norm an understood rule for accepted and
expected behavior
- Slide 4
- General issues Symptoms of psychiatric illness In general
medicine, symptom refers to an abnormality reported by the patient,
while sign refers to an abnormality detected by the doctor by
observation or clinical examination. In psychiatry, the terms
symptom and sign tend to be used synonymously because abnormalities
of mental state can only be elicited by exploring, with the
patient, their internal experiences.
- Slide 5
- Endogenous vs. reactive :These terms have been largely made
outmoded by developments in understanding of mental disorders, but
are still seen occasionally. It was formerly thought that some
conditions arose in response to external events (e.g. depression
arising after job loss) (reactive), while others arose
spontaneously from within (endogenous). Psychotic vs. neurotic: in
present classifications these terms are used purely descriptively
to describe two common types of symptoms that may occur in a
variety of mental disorders. Previously, they were used to
distinguish those disorders characterized by impairment of insight,
abnormal beliefs, and abnormal perceptual experiences from those
where there was preserved insight but abnormal affect.
- Slide 6
- Structural vs. functional: A distinction formerly made between
those brain disorders with observable structural abnormalities on
post-mortem (e.g. Alzheimer's disease) and those without (e.g.
schizophrenia). This usage has diminished since the discovery of
definite observable brain changes in those disorders formerly
called (functional psychoses). Nowadays, the term is more often
used in neurology/ neuropsychiatry to distinguish syndromes which
generally have abnormal investigation findings (e.g. multiple
sclerosis) from those without (e.g. conversion paralysis).
- Slide 7
- Cultural variations in psychopathology: Symptoms are similar in
their form in widely different cultures. However there are cultural
differences in the symptoms which revealed to doctors; depression
in eastern countries report more somatic complaints than western
people as they report more mood symptoms. In some countries the
effects of psychiatric disorders are ascribed to witchcraft and
ghosts while in more civilized countries are not. In some cultures
mental disorders are stigmatized and make patients burden
more.
- Slide 8
- Disturbances of mood and affect Mood The subjective experience
of feeling or emotion as described by the patient in the history.
Mood is a pervasive and sustained emotion, is not influenced by
will, and is strongly related to values.. It is distinct from
Affect (see definition), which is a feeling state noted by the
examiner during the mental status examination.
- Slide 9
- The principal but not the only domain of symptoms in mood
disorders is the extent and type of mood deviation. Although there
are no sharp boundaries between the normal variations and
pathological states of mood, the severe states are clearly abnormal
and difficult to empathize. Mood can be abnormal in several ways:
Euthymic : normal range of mood. dysphoric : unpleasant mood.
depression: psychopathological feeling of sadness. Anhedonia: loss
of interest in, and withdrawal from all pleasurable activities,
often associated with depression. Alexithymia: a persons inability
to, or difficulty in, describing or being aware of emotions or
mood. Expansive: a persons expression of feelings without
restraint. Irritable: a state a person is easily annoyed and
provoked to anger. Labile : oscillation between euphoria and
depression.
- Slide 10
- Elevated: air of confidence and enjoyment, mood more cheerful
than normal. Euphoria: intense elation with felling of grandeur.
Elation: felling of joy, euphoria, triumph, intense self
satisfaction and optimism. Hypomania: Mania: mood state
charecterized by elation, agitation, hyperactivity, hypersexuality,
and accelerated thinking and speaking. La belle indifference: in
apropriate attitude of calm or lack of concern about ones
disability. Emotional incontinence: extreme variation in
emotion
- Slide 11
- Disturbances of affect 1-apropriate 2-inapropriate 3-restricted
4-flat 5-blunted 6-labile
- Slide 12
- Disturbances of perception Perception is a complex process
which is not restricted to the screening of physical signals by
sense organs but implies the processing of these data to represent
reality. Imagery: is the awareness of a percept that has been
generated within the mind. Imagery can be called up and terminated
by an effort of will(voluntary).
- Slide 13
- illusion Illusions are misperceptions of external stimuli or a
type of false perception in which the perception of a real world
object is combined with internal imagery to produce a false
internal percept. They occur when the general level of sensory
stimulation is reduced and when attention is not focused on the
relevant sensory modality. Also occur in anxiety and delirium.
- Slide 14
- hallucination A false sensory perception of something that is
not there i.e. in the absence of external real stimuli. An Illusion
(see definition) differs in being a perceptual distortion of
something that is there. A true hallucination will be perceived as
in external space, distinct from imagined images, outside conscious
control, and as possessing relative permanence. A pseudo-
hallucination will lack one or all of these characteristics. A
hallucination is not always a sign of psychosis.
- Slide 15
- Hallucinations are sub-divided according to their modality of
sensation and may be: 1- Auditory hallucinationsfalse perceptions
of sounds (voices, music, buzzing, motor noises, murmuring).(second
person, third person) 2- Gustatory hallucinationsfalse perceptions
of taste. 3- Olfactory hallucinationsfalse perceptions of smell. 4-
Visual hallucinationsfalse visual perceptions with eyes open in a
lighted environment. (Visual images with the eyes closed are not
true hallucinations. 5- Tactile hallucinationsfalse sensations of
touch. (Usually associated with a delusion consistent with the
sensation.) Formication :a particular type of tactile
hallucination, is the sensation of bugs crawling on or under the
skin. Hypnagogic and hypnopompic hallucinationsimages experienced
during the twilight stages while falling asleep and waking up,
respectivelyare not true hallucinations.)
- Slide 16
- All of the above hallucinations can occur in schizophrenia,
affective disorders, and organic mental disorders. Visual
hallucinations are suggestive of organic mental disorders but are
seen in functional disorders. Gustatory, olfactory, and tactile
hallucinations strongly suggest organic mental disorders. Tactile
hallucinations are common in drug and alcohol withdrawal and
intoxication states. Autoscopic hallucination: is the experience of
seeing ones own body projected in to external space, usually in
front of oneself, for short periods..near death experience???!
Reflex hallucination: a stimulus in one sensory modality results in
hallucination in another..music-----visual hallucination.
- Slide 17
- Disturbances of thought Thinking is goal directed flow of
ideas, symbols, and associations initiated by a problem or task and
leading toward a reality-oreinted conclusion. Types of thinking: 1-
Fantasy thinking (also called autistic thinking) produces ideas
which have no external reality. This process can be completely
non-goal-directed, even if the subject is to some extent aware of
the mood, affect, or drive which motivates it. 2- Rational
(conceptual) thinking attempts to resolve a problem through the use
of logic, excluding fantasy. The accuracy of this endeavour depends
on the person's intelligence, which can be affected by various
disturbances of the different components involved in understanding
and reasoning. 3- Imaginative thinking can be located between the
fantasy thinking and rational thinking. It is a process of forming
a representation of an object or a situation using fantasy but
without going beyond the rational and possible.
- Slide 18
- Disturbances in form of thought 1-neologism: new words created
by a patient. 2-word salad: incoherent mixture of words and
phrases. 3-circumstantiality: indirect speech that is delayed in
reaching the point but eventually gets from original point to
desired goal. 4-tangentiality: in ability to have goal-directed
associations of thought; never gets from point to desire goal.
5-perseveration: persisting response to a previous stimulus after a
new stimulus have been presented. 6-verbigeration: meaningless
repetition of words or phrases. 7-echolalia: psychopathological
repetition of words or phrases of one person by another person.
8-irrelevant answer:
- Slide 19
- 9-Loosening of association: flow of thought in which ideas
shift from one subject to another in a completely unrelated way.
10-flight of ideas: rapid, continious verbalizations or plays on
words produce constant shifting from idea to another, ideas tend to
be connected. 11-clang association: association of words similar in
sound but not in meaning. 12-blocking: 13-glossolalia: private
spoken language.
- Slide 20
- Disturbances in content of thinking 1-poverty : 2-over valued
ideas: A form of abnormal belief. These are ideas which are
reasonable and understandable in themselves but which come to
unreasonably dominate the patient's life. 3-delusions :An abnormal
belief which is held with absolute subjective certainty, which
requires no external proof, which may be held in the face of
contradictory evidence, and which has personal significance and
importance to the individual concerned. Excluded are those beliefs
which can be understood as part of the subject's cultural or
religious background. While the content is usually demonstrably
false and bizarre in nature, this is not invariably so.
- Slide 21
- Types of delusions (contents) 1-Delusions of persecution, i.e.,
being followed, harassed, threatened, or plotted against. 2-
Delusions of grandeur, i.e., being influential and important,
perhaps having occult powers, or actually being some powerful
figure out of history (Napoleonic complex). 3- ) Delusions of
reference, i.e., external events or portents have personal
significance, such as special messages or commands. A person with
delusions of reference believes that strangers on the street are
talking about him or her, the television commentator is sending
coded messages, etc. 4- delusions of love characterized by the
patient's conviction that another person is in love with him or
her. 5- Delusions of guilt :A delusional belief that one has
committed a crime or other reprehensible act. A feature of
psychotic depressive illness. 6- Delusions of control: The core
feature is the delusional belief that one is no longer in sole
control of one's own body. The individual delusions are that one is
being forced by some external agent to feel emotions, to desire to
do things, to perform actions, or to experience bodily
sensations.(withdrawal, insertion, broad casting)
- Slide 22
- 7- hypochondriacal delusions founded on the conviction of
having a serious disease. 8- Delusional jealousy: A delusional
belief that one's partner is being unfaithful (Othello syndrome) 9-
Delusional misidentification: A delusional belief that certain
individuals are not who they externally appear to be. The delusion
may be that familiar people have been replaced with outwardly
identical strangers (Capgras syndrome) or that strangers are
(really) familiar people (Fraegoli syndrome). A rare symptom of
schizophrenia or of other psychotic illnesses. 10- Delusions of
thought interference: A group of delusions which are considered
first-rank symptoms of schizophrenia. They are thought insertion,
thought withdrawal, and thought broadcasting. 11- Folie deux
(madness for two): A disorder characterized by the sharing of
delusional (usually persecutory) ideas by two or more (folie
plusieurs) individuals living in close association, usually in a
family relationship. One member of the pair (or group) seems always
to influence and dominate the other(s). The delusional ideas may
lead to strange types of behavior such as preparing for the end of
the world 12-nihilistic delusion: A delusional belief that the
patient has died or no longer exists or that the world has ended or
is no longer real. Nothing matters any longer and continued effort
is pointless. A feature of psychotic depressive illness
- Slide 23
- 13-Pseudologica fantastica: a type of lying in which a person
appears to believe in the reality of his fantasies and act on them.
4- obsession : Recurring ideas, images, or wishes that dominate
thought. The content may be unacceptable and actively resisted but
intrudes into consciousness again and again. A feature of
obsessive-compulsive disorder and some cases of schizophrenia.
5-compulsion :A behavior or action which is recognised by the
patient as unnecessary and purposeless but which he cannot resist
performing repeatedly (e.g. hand washing). 6-phobia : A particular
stimulus, event, or situation which arouses anxiety in an
individual and is therefore associated with avoidance.
7-Hypochondriasis : The belief that one has a particular illness
despite evidence to the contrary. Its form may be that of a primary
delusion, an overvalued idea, a rumination, or a mood congruent
feature of depressive illness.
- Slide 24
- Motor symptoms and signs Motor symptoms and signs may be due to
a neurological disorder causing organic brain syndrome, such as
rigidity in Parkinson's disease, or may be related to emotional
states such as restlessness or tremor in anxiety. However, there is
a further group of symptoms which affect voluntary movements and
often occur in functional psychoses. These symptoms are neither
unequivocally neurological nor clearly psychogenic in origin and
are termed motility disorder by some authors.
- Slide 25
- Slide 26
- Tics are rapid irregular movements involving groups of facial
or limb muscles. Mannerism Abnormal and occasionally bizarre
performance of a voluntary, goal-directed activity (e.g. a
conspicuously dramatic manner of walking. Stereotypy A repetitive
and bizarre movement which is not goal directed (in contrast to
mannerism). The action may have delusional significance to the
patient. Seen in schizophrenia. Catatonia A syndrome characterized
by cataleptic posturing, stereotypy, mutism, stupor, negativism,
automatic obedience, echolalia, and echopraxia. There are two
subtypes: excited and retarded. The excited subtype is
characterized by dramatic increases in motor behavior, occasionally
to the point of physical collapse; the retarded subtype is
characterized by slowed motor behavior, occasionally to the point
of immobility. Catalepsy A rare motor symptom of schizophrenia.
Describes a situation in which the patient's limbs can be passively
moved to any posture which will then be held for a prolonged period
of time. Also known as waxy flexibility or flexibilitas cerea.
(psychological). pillow. Posturing The assumption of various
abnormal bodily positions, often a feature of catatonia.
- Slide 27
- Negativism A motor symptom of schizophrenia where the patient
resists carrying out the examiners instructions and his attempts to
move or direct the limbs. Echopraxia Imitation of another person's
movements. (Echolalia and echopraxia are seen in pervasive
developmental disorders, organic mental disorders, catatonia, and
other psychotic disorders.) Ambitendency series or uncertain,
incomplete movements carried out when a voluntary action is
anticipated.
- Slide 28
- Disorders of memory Memory may be differentiated into
short-term or recent memory and long-term or remote memory.
Furthermore, ultra- short-term memory may be distinguished from
short-term memory. Ultra-short-term memory encompasses immediate
registration within the span of attention. Short-term memory
reflects new learning. Long-term memory is usually associated with
earlier data or other information that has been stored for months
or years.
- Slide 29
- Amnesia : is a period of time which cannot be recalled and it
may be global or partial. With regard to time it may be: 1-
retrograde amnesia : an expression derived from the idea that one
is looking backwards from an event (such as brain trauma or
electroconvulsive therapy) to find the period before the event to
be deleted. Correspondingly, 2- anterograde amnesia: means a period
of deleted memory after an event. Although it is difficult to
distinguish between types of amnesia, focal lesions in the
hippocampus seem to affect remote memory less than recent memory,
whereas diffuse brain disease often affects both. In psychogenic
amnesia it is sometimes possible to recognize specific personal
meaning in the events which cannot be recalled. Some patients are
aware of memory disorder and complain about it; others tend to
neglect their memory deficits and manifest secondary signs such as
confabulations. Confabulations are inventions which substitute for
missing contents in gaps of memory; the patient is not aware that
they are not true memories
- Slide 30
- Dj vu : A sense that events being experienced for the first
time have been experienced before. An everyday experience but also
a non- specific symptom of a number of disorders including temporal
lobe epilepsy, schizophrenia, and anxiety disorders. Jamais vu: The
sensation that events or situations are unfamiliar, although they
have been experienced before. An everyday experience but also a
non-specific symptom of a number of disorders including temporal
lobe epilepsy, schizophrenia, and anxiety disorders.
- Slide 31
- Disorders of consciousness Consciousness: is awareness of self
and environment. Coma: is the most extreme form of impaired
consciousness, the patient show no external evidence of mental
activity and little motor activity other than breathing. Clouding
of consciousness Conscious level between full consciousness and
coma. Covers a range of increasingly severe loss of function with
drowsiness and impairment of concentration and perception. Stupor
(stoo-per): A condition where a person is immobile, mute, and
unresponsive, but appears to be fully conscious because the eyes
are open and follow the movement of external objects. Confusion The
core symptom of delirium or acute confusional state. There is
disorientation, clouding of consciousness and deterioration in the
ability to think rationally, lay down new memories, and to
understand sensory input. Twilight state is a well-defined
interruption of the continuity of consciousness. Consciousness is
clouded and sometimes narrowed. Despite the disorder of
consciousness the patient is able to perform certain actions, such
as dressing, driving, or walking around. Subsequently, there is
amnesia for this state. Twilight states may occur in epilepsy,
alcoholism, brain trauma, general paresis, and dissociative
disorder.
- Slide 32
- oneiroid state: the patient experiences narrowing of
consciousness together with multiple scenic hallucinations.
Oneiroid states may occur in schizophrenia, but are also observed
in patients under intensive care who have to be totally passive and
dependent on others. The atmosphere is perceived as strange and
dreamlike. Accordingly patients may be aloof and behave like
dreamers. (72) Unlike twilight states, the contents of oneiroid
states are often remembered.72 Finally, it should be noted that the
subconscious of psychoanalytical theory is not open to direct
clinical examination.
- Slide 33
- Insight The clinical assessment of a patient's capacity to
understand the nature, significance, and severity of his or her own
illness has been called insight. insight is composed of three
overlapping dimensions: the ability to relabel unusual mental
events as pathological, the recognition that one has mental
illness, and compliance with treatment.
- Slide 34
- Thank you